Spasmodic Dysphonia Pain

This study aims to identify adjuvant methods to improve patient comfort during in-office laryngology procedures.

Hypothesis: The use of local anesthetic or vibrating instrument will decrease overall pain experienced by a patient with spasmodic dysphonia undergoing Botox injections. Aims, purpose, or objectives: To identify adjuvant methods to improve patient comfort during in-office laryngology procedures. Results demonstrated here should be transferrable to other transcutaneous in-office procedures in laryngology. Background: Spasmodic dysphonia is a vocal disorder characterized by uncontrollable voice breaks. Injection of botulinum neurotoxin into the laryngeal muscles is the mainstay of treatment. Patients require repeated treatments due to the temporary effect of botulinum neurotoxin. Laryngeal injections are commonly performed through the skin of the neck and can be associated with pain and discomfort. Local anesthetic administration prior to laryngeal injection is commonly performed in clinical practice, however its efficacy hasn't been evaluated and a third of surveyed otolaryngologists do not administer local anesthesia prior to the laryngeal injection of botulinum neurotoxin. Vibratory anesthesia involves the application of a local vibratory stimulus and has been found to reduce pain during various needle-related procedures. Vibratory anesthesia has not previous been evaluated for laryngeal injections. This study will utilize the need for spasmodic dysphonia patients to receive repeated injections to incorporate a crossover design where patients receive three consecutive laryngeal injections of botulinum toxin experiencing injection without additional anesthesia, with local anesthesia, and with vibration anesthesia in a randomized order.

Patients will receive laryngeal injection of Botox via a transcricothyroid approach without additional anesthesia

Patients will receive laryngeal injection of Botox via a transcricothyroid approach following subcutaneous injection of 0.5cc 2% lidocaine in 1:100,000 epinephrine (done approximately 2 minutes before Botox injection)

Patients will receive laryngeal injection of Botox via a transcricothyroid approach while a vibrating instrument is held adjacent to cricothyroid space

Inclusion Criteria: Spasmodic dysphonia with or without tremor Receiving botox as treatment via a transcricothyroid approach Exclusion Criteria: - Allergy to lidocaine